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Paranasal Sinus and Nasal Cavity Cancer Treatment (PDQ®)

Treatment Option Overview

Except for T1 mucosal carcinomas, the accepted method of treatment is a
combination of radiation therapy and surgery. The incidence of lymph node
metastases is generally low (approximately 20% of all cases). Thus, routine
radical neck dissection or elective neck radiation therapy is recommended only for
patients presenting with positive nodes.

For patients with operable tumors,
radical surgery is generally performed first to remove the bulk of the tumor
and to establish drainage of the affected sinus(es). This is followed by
postoperative radiation therapy. Some institutions continue to give a full
dose of radiation therapy preoperatively for all stage II and stage III tumors and
to operate 4 to 6 weeks later.[1-3] A review of published clinical results of
radical radiation therapy for head and neck cancer suggests a significant loss
of local control when the administration of radiation therapy was prolonged;
therefore, lengthening of standard treatment schedules should be avoided
whenever possible.[4]

Surgery

Surgical exploration may be required to determine operability.

Destruction of
the base of skull (i.e., anterior cranial fossa), cavernous sinus, or the pterygoid
process; infiltration of the mucous membranes of the nasopharynx; or
nonresectable lymph node metastases are relative contraindications to surgery.
Surgical approaches include fenestration with removal of the bulk tumor, which
is usually followed by radiation therapy or block resection of the upper jaw.
A combined craniofacial approach, including resection of the floor of the
anterior cranial fossa is used with success in selected patients.[5] Removal of
the eye is performed if the orbit is extensively invaded by cancer. Clinically
positive nodes, if resectable, may be treated with radical neck dissection.

Radiation Therapy

Radiation therapy must be carried to high doses for any significant probability
of permanent control. The treatment volume must include all of the maxillary
antrum and involved hemiparanasal sinus and contiguous areas. The orbit and
its contents are excluded except under unusual circumstances. Lymph nodes of
the neck, when palpable, should be treated in conjunction with treatment of
advanced carcinomas of the antrum. This may be unnecessary for early tumors.

Accumulating evidence has demonstrated a high incidence (>30%–40%) of
hypothyroidism in patients who have received external-beam radiation therapy to the
entire thyroid gland or to the pituitary gland. Thyroid function testing of
patients should be considered prior to therapy and as part of posttreatment
follow-up.[6,7]

Recurrent Disease

For patients with recurrent disease, chemotherapy trials should be considered.
Chemotherapy for recurrent squamous cell cancer of the head and neck has been
shown to be efficacious as palliation and may improve quality of life and
length of survival. Various drug combinations including cisplatin,
fluorouracil, and methotrexate are effective.[8,9]

Treatment of tumors of the paranasal sinuses and of the nasal cavity should be
planned on an individual basis because of the complexity involved.